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Yes, Medicine Can Use Virtual Reality, Emphasis on Reality

By Abigail Zuger, M.d. August 15, 2016 2:37 pmAugust 15, 2016 2:37 pm

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You’d think medicine would be the last holdout against virtual reality. After all, the body is the body — solid flesh, no faking it, no escaping it. We may turn books into bytes, create driverless cars and soldierless wars; but even patched with plastic and titanium and attached to external electric circuits, the body is still where medicine does business.

Not that we haven’t tried to circumvent it. We have created virtual patients of all varieties; we have sleek external tools to inspect messy internal organs. In the end, we always snap back to reality.

Our students are the ones most burdened by that transition from the virtual to the real: Virtual medicine is created for them. Decades ago, a plastic doll designed to simulate a dying patient was trademarked “Resusci Anne.” A generation of doctors and nurses learned CPR on her plastic chest, and then went on to learn that real chests feel very different, that real ribs reliably crack under pressure.

Those training dummies are now far more advanced than poor old Annie. The most sophisticated will flounder like a real dying patient, with agonal breathing, dilated pupils and all the complex distress of a failing heart. These dummies accept IV lines and throat tubes.

Even more advanced are the virtual patients who are actually human — but not patients. They are actors, some paid professionals, some volunteers, who allow students to practice interviewing and diagnosing.

Just like real patients, “standardized patients” can be difficult and demanding or utterly charming. They can also snap out of character to tell the trainee where it all went wrong, something a real patient seldom dares to do.

Surgeons and pathologists can learn without risk in a virtual surgical theater, wielding a virtual scalpel on a screen.

And even when health care winds down, virtual reality now intrudes. A “virtual autopsy” puts the deceased under a CT scanner instead of the pathologist’s knife. The results are reasonably accurate, even more so when combined with small biopsies of major organs.

And yet for all this virtual training, the moment of truth always comes. A real patient with a real problem walks in, or arrives on a screeching gurney. The patient has a real torso and real ribs, or a real appendix, or a real attitude, or really terrible insurance, and the virtual experience dissolves in an instant.

Does a deep immersion in virtual medicine make real situations any easier? I’m not sure it does, not if all the anxious, stammering students and residents out there are evidence. For all their virtual training, the real is still terrifying for them, their proficiency just as slow to develop and just as hard won.

Some doctors who look back on that long painful process begin to feel strongly about giving something back to help their successors along. Often they decide to donate their bodies to educate incoming students. Cadavers for the anatomy course are always in short supply, and paying it forward with that kind of donation often seems only fair.

The more I think about it, though, the more I wonder if it is really enough. To call the cadaver dissected at the beginning of medical school a student’s “first patient” always seemed silly to me. The cadavers are, perhaps, their first virtual patients. The first living patients are far more transformative.

So I have been thinking that perhaps I will donate my body while still alive. Let the young snap out of their virtual reality and practice on me.

At the moment, I have no illnesses, but some are bound to occur. And then I will let medical students ask me personal questions off an endless list. I will let interns and residents ask the same questions, over and over. “What? Again?” I will say, as all patients do. “Don’t you people write anything down?” But I’ll keep talking.

I’ll let students start IVs and residents do the cardiogram and try the spinal tap and repeat the blood cultures and, yes, maybe even pound on my real chest. I will never once say: “That’s it. Go away. Get me a real doctor.”

Call me a nonvirtual patient (or, perhaps, a real dummy). Perhaps my resolve will fail when the time comes to be a real patient, but I hope not. Really, it seems only fair.

And speaking of optimal endings: After two decades writing this column more or less regularly for Science Times, I have come to the last one. The time has come to try for longer thoughts.

Back in 1998, I landed a major scoop: the news that stethoscopes were getting longer. A leading stethoscope manufacturer confirmed on the record that doctors wanted a little more distance from their patients.

Sometimes I think that everything I have written since has been just a variation on that theme, stories of doctors and patients perhaps a little farther apart than we think we remember, their bonds a little strained but still strong, still elastic, still resonating to a familiar beat.

A version of this article appears in print on 08/16/2016, on page D3 of the NewYork edition with the headline: Hard Cases; Nothing Virtual About Reality.